眼震电图在梅尼埃病和椎基底动脉供血不足鉴别诊断中的研究
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摘要
目的：了解眼震电图在椎基底动脉供血不足和梅尼埃病诊断中的鉴别价值。方法：
临床40例梅尼埃病的病人和20例椎基底动脉供血不足病人进行眼震电图检查并
分析，20例正常人作对照。结果：1．两者前庭冷温试验均多有异常，40例梅尼埃
病中CP、CP+DP共34例，20例椎基底动脉供血不足中CP、CP+DP15例，差
异无显著性（P＞0.05）。2．两病不同组合的视动异常（扫视、视跟踪、视动），20
例椎基底动脉供血不足中共17例，明显较40例梅尼埃病病例共6例多，差异有
显著性（P＜0.01=；我们也把两种疾病的视动试验、视跟踪的增益及扫视的潜伏
期和精度分别进行统计分析，得出椎基底动脉供血不足视动、视跟踪增益明显低
于梅尼埃病（P＜0.05=，扫视潜伏期和精度与梅尼埃病相差不大（P＞0.05），但临
床上我们只把三项检查组合在一起分析。3．凝视异常与固视抑制失败因两病出现
均少，而未做统计分析；4．位置性眼震中，梅尼埃病17/40、椎基底动脉供血不足
10/20与自发性眼震分别为梅尼埃病15/40，椎基底动脉供血不足2/20，两者差
异无显著性（P＞0.05）。结论：椎基底动脉供血不足视动中枢试验异常远较梅尼埃
病的病人多，眼震电图可以用于两种疾病的鉴别诊断。
Objective: To study the differential diagnosis value of ENG
between VBI and MID. Methods: Examining with ENG and analyzing 40
clinical patients of MID and 20 patients of VBI. Results: 1 .Much subject
get abnormal result in caloric test in both disease patients, there are 34
patients abnormal in CP or CP + DP in 40 MD patients and 15 patients of
20 VBI patients , so the difference is not remarkable (P>0.05) . 2. For the
different compound abnormal OPN (include Optokinetic, Smooth pursuit,
Voluntary Saccade), there are 17 patients of 20 VBI patients and is much
more than 6 patients of 40 patients (P<0.0 1). We also analysis the gain
data of the three test respectively in both diseases that gains of Optokinetic
and Soomth pursuit is lower obviously than in MD(P < 0.05) 慽n VBJ
however the data of Delay or Accuracy of Voluntary Saccade is simile to in
MD(P>O.05). We just analysis the three tests as one compound test in our
clinical examining. 3. For abnormal Gaze and Failure of fixation
Suppression, there are too little patients were found, we don抰 analysis the
data. 4. For abnormal Spontaneous there are 17 patients of 40 MD patients
and 10 patients of 20 VBI patients, and for abnormal Positional there are
15 patients of 40 MD patients and 2 patients of 20 VBI patients, three are
not distinctly difference (P>0.05). Conclusion: Much more patient of
VBI get abnormal results in compound Optokinetic testing than patients of
MD ENG may use for differential diagnosis between Meniere and VBI.
临床40例梅尼埃病的病人和20例椎基底动脉供血不足病人进行眼震电图检查并
分析，20例正常人作对照。结果：1．两者前庭冷温试验均多有异常，40例梅尼埃
病中CP、CP+DP共34例，20例椎基底动脉供血不足中CP、CP+DP15例，差
异无显著性（P＞0.05）。2．两病不同组合的视动异常（扫视、视跟踪、视动），20
例椎基底动脉供血不足中共17例，明显较40例梅尼埃病病例共6例多，差异有
显著性（P＜0.01=；我们也把两种疾病的视动试验、视跟踪的增益及扫视的潜伏
期和精度分别进行统计分析，得出椎基底动脉供血不足视动、视跟踪增益明显低
于梅尼埃病（P＜0.05=，扫视潜伏期和精度与梅尼埃病相差不大（P＞0.05），但临
床上我们只把三项检查组合在一起分析。3．凝视异常与固视抑制失败因两病出现
均少，而未做统计分析；4．位置性眼震中，梅尼埃病17/40、椎基底动脉供血不足
10/20与自发性眼震分别为梅尼埃病15/40，椎基底动脉供血不足2/20，两者差
异无显著性（P＞0.05）。结论：椎基底动脉供血不足视动中枢试验异常远较梅尼埃
病的病人多，眼震电图可以用于两种疾病的鉴别诊断。
Objective: To study the differential diagnosis value of ENG
between VBI and MID. Methods: Examining with ENG and analyzing 40
clinical patients of MID and 20 patients of VBI. Results: 1 .Much subject
get abnormal result in caloric test in both disease patients, there are 34
patients abnormal in CP or CP + DP in 40 MD patients and 15 patients of
20 VBI patients , so the difference is not remarkable (P>0.05) . 2. For the
different compound abnormal OPN (include Optokinetic, Smooth pursuit,
Voluntary Saccade), there are 17 patients of 20 VBI patients and is much
more than 6 patients of 40 patients (P<0.0 1). We also analysis the gain
data of the three test respectively in both diseases that gains of Optokinetic
and Soomth pursuit is lower obviously than in MD(P < 0.05) 慽n VBJ
however the data of Delay or Accuracy of Voluntary Saccade is simile to in
MD(P>O.05). We just analysis the three tests as one compound test in our
clinical examining. 3. For abnormal Gaze and Failure of fixation
Suppression, there are too little patients were found, we don抰 analysis the
data. 4. For abnormal Spontaneous there are 17 patients of 40 MD patients
and 10 patients of 20 VBI patients, and for abnormal Positional there are
15 patients of 40 MD patients and 2 patients of 20 VBI patients, three are
not distinctly difference (P>0.05). Conclusion: Much more patient of
VBI get abnormal results in compound Optokinetic testing than patients of
MD ENG may use for differential diagnosis between Meniere and VBI.
引文
1 颜文辉 韩丽英 刘林勇．阈值强度刺激 BAEP 检测在梅尼埃病的应用．临床脑 电脑杂志，1999；8(2) ：82-84
2 Margolis RH，Rieks D，Foumier EM，Levine SE．Tympanic electrocochleography for diagnosis of Meniere’S disease. Arch Otolaryngol Head Neck Surg．1995 Jan；121(1) ：44-55．
3 Tibbils RP．SP／AP area ratio in the diagnosis of Meniere’S disease．Am-J-Audiol． 1999 Jun；8(1) ：21-8
4 张建宏 边连防 范建中．脑干听觉诱发电位对椎基底动脉供血不足的评定价值． 中华理疗杂志，1999． 04． 20；22(2) ：81-83
5 张合 沈静等．脑干缺血对听觉脑干反应影响的实验研究．中国应用生理学杂 志 1999． 08． 28；15(3) ：201-205
6 王兆玉等．椎基底动脉供血不足的脑干听觉诱发电位研究．中华神经精神科杂 志，1992；25：41
7 石明等．颈椎病-椎基底动脉供血不足患者眼震电图诊断价值的对比研究．现代医 学杂志，1992；2：18
8 丁铭臣等．眼震电图诊断早期椎基底动脉系统缺血性疾病的临床价值．中国神经 精神疾病杂志；1987；13：326
9 羊毅等．椎基底动脉供血不足脑干听觉诱发电位与脑血流图对比研究．湖南医 学；1992；9：323．
10 吕冰清等．椎基底动脉缺血的早期诊断-ENG、BAEP与 SPECT 的对照研究． 临床神经病学杂志；1994；7(1) ：28-30
11 王正敏．梅尼埃病．耳鼻喉科学新理论与新技术(第一版)．上海科技教育出版社 1997年12月：34-35．
12 方岩．短暂性脑缺血．临床脑血管疾病(第一版)．河南科技出版社1998：124
13 魏能润等．自发性与诱发性眼震．湖北科技出版社，1986． 4
14 Baloh RW, Honrubia V.The central vestibular system.Contemp Neurol Ser. 1979;18:47-99．
15 樊忠 王天铎．实用耳鼻咽喉科学(第一版)．山东科学技术出版社．1997． 2．
16 李学佩 马芙蓉 王伟．椎基底动脉供血障碍对前庭血况的影响．北京医科大学学 报；1997；29(5) ．451-453．
17 Kinney WC, Wallace RC, Ross JS, Kinney SE, Hamid MA.Retrospective blinded review of magnetic resonance imaging in patients with central electronystagmography findings.Am J Otol. 1998 May;19(3) :341-4．
18 罗宇 井晓蓉等．椎基底动脉供血不足性眩晕四种检查比较．临床脑电 学；1999；8：3． 154-156
19 Linthicum FH, Waldorf R, Luxford WM, Caltogirone S .Infrared/video ENG recording of eye movements to evaluate the inferior. Otolaryngol Head Neck Surg ,1988 Mar;98(3) :207-10
20 石明等．眼震电图对眩晕的鉴别诊断价值探讨．湖南医科大学学报，1997，22(2) ： 156-158．
21 Baloh RW, Honrubia V.Clinical neurophysiology of the vestibular system.Contemp Neurol Ser. 1979; 18:1-21．
22 Wilson VJ, Peterson BW, Fukushima K, Hirai N, Uchino Y.Analysis of vestibulocollic reflexes by sinusoidal polarization of vestibular afferent fibers.J Neurophysiol. 1979 Mar;42(2) :331-46．
23 Stroud MH, Newman NM, Keltner JL, Gay AJ.Abducting nystagmus in the medial longitudinal fasciculus (MLF) syndrome-internuclear ophthalmoplegia (INO).Arch Ophthalmol. 1974 Jul;92(1) :2-5．
24 Buizza A, Schmid R.Visual-vestibular interaction in the control of eye movement: mathematical modelling and computer simulation.Biol Cybern. 1982;43(3) :209-23．
25 Baloh RW, Yee RD, Honrubia V. Optokinetic asymmetry in patients with
maldeveloped foveas. Brain Res. 1980 Mar 17; 186( 1 ):211-6．
26 Ito M.Cerebellar control of the vestibulo-ocular reflex around the flocculus hypothesis.Annu Rev Neurosci. 1982;5:275-96．
27 Baloh RW, Yee RD, Kimm J, Honrubia V.Vestibular-ocular reflex patients with lesions involving the vestibulocerebellum.Exp Neurol. 1981 Apr;72(l):141-52．
28 Ito M, Shiida T, Yagi N, Yamamoto M.Visual influence on rabbit horizontal vestibulo-ocular reflex presumably effected via the cerebellar flocculus.Brain Res. 1974 Jan 4;65(1) : 170-4．
29 Kato I, Nakamura T, Kimura Y, Koike Y, Mizukoshi K.Visual-vestibular interaction in central nervous system disorders.Ann N Y Acad Sci. 1981 ;374:764-73．
30 Godaux E, Gobert C, Halleux J.Vestibuloocular reflex, optokinetic response, and their interactions in the alert cai.Exp Neurol. 1983 Apr;80(1) :42-54．
31 Godaux E, Vanderkelen B.Vestibulo-ocular reflex, optokinetic response and their interactions in the cerebellectomized cat.J Physiol. 1984 Jan;346:155-70．
32 Iwauga K, Morik. A case of HTLV-I associated myelopathy with flutter-like osillation. Rinsho, shinkeigaka 1993 Jan;37(1) :83-85, Japanese.
33 赵沛英等．视抑制试验的临床应用研究．中华耳鼻咽喉科杂志．1994：29． 6：359-361
34 Benitez JT.Eye-tracking and optokinetic tests: diagnostic significance in peripheral and central vestibular disorders. Laryngoscope. 1970 Jun;80(6) :834-48．
35 Kveton JF, Limb CJ, Bell MD.Comparison of optokinetic nystagmus elicited by full versus partial visual field stimulation: diagnostic implications. Otolaryngol Head Neck Surg. 1999 Jul;121(l):52-6． .
36 张素珍 姜泗长等。1000例眼震电图分析。中华耳鼻咽喉科杂志，1989； 24(6) ：355-358
37 单希征等．丛棘波在眼震电图中的意义．中华耳鼻咽喉科杂志，1992：27． 4：214-215
38 林尚泽 位置性眼震的临床意义。国外医学耳鼻咽喉科学分册，1998：22 (4) ： 227-228
39 Cawthome T．Examination of the vestibular system．Ann Otol Rhinol Laryngol．1968 Aug；77(4) ：727-32
40 王博惕 王丽雯．耳神经学．人民军医出版社，1987．
2 Margolis RH，Rieks D，Foumier EM，Levine SE．Tympanic electrocochleography for diagnosis of Meniere’S disease. Arch Otolaryngol Head Neck Surg．1995 Jan；121(1) ：44-55．
3 Tibbils RP．SP／AP area ratio in the diagnosis of Meniere’S disease．Am-J-Audiol． 1999 Jun；8(1) ：21-8
4 张建宏 边连防 范建中．脑干听觉诱发电位对椎基底动脉供血不足的评定价值． 中华理疗杂志，1999． 04． 20；22(2) ：81-83
5 张合 沈静等．脑干缺血对听觉脑干反应影响的实验研究．中国应用生理学杂 志 1999． 08． 28；15(3) ：201-205
6 王兆玉等．椎基底动脉供血不足的脑干听觉诱发电位研究．中华神经精神科杂 志，1992；25：41
7 石明等．颈椎病-椎基底动脉供血不足患者眼震电图诊断价值的对比研究．现代医 学杂志，1992；2：18
8 丁铭臣等．眼震电图诊断早期椎基底动脉系统缺血性疾病的临床价值．中国神经 精神疾病杂志；1987；13：326
9 羊毅等．椎基底动脉供血不足脑干听觉诱发电位与脑血流图对比研究．湖南医 学；1992；9：323．
10 吕冰清等．椎基底动脉缺血的早期诊断-ENG、BAEP与 SPECT 的对照研究． 临床神经病学杂志；1994；7(1) ：28-30
11 王正敏．梅尼埃病．耳鼻喉科学新理论与新技术(第一版)．上海科技教育出版社 1997年12月：34-35．
12 方岩．短暂性脑缺血．临床脑血管疾病(第一版)．河南科技出版社1998：124
13 魏能润等．自发性与诱发性眼震．湖北科技出版社，1986． 4
14 Baloh RW, Honrubia V.The central vestibular system.Contemp Neurol Ser. 1979;18:47-99．
15 樊忠 王天铎．实用耳鼻咽喉科学(第一版)．山东科学技术出版社．1997． 2．
16 李学佩 马芙蓉 王伟．椎基底动脉供血障碍对前庭血况的影响．北京医科大学学 报；1997；29(5) ．451-453．
17 Kinney WC, Wallace RC, Ross JS, Kinney SE, Hamid MA.Retrospective blinded review of magnetic resonance imaging in patients with central electronystagmography findings.Am J Otol. 1998 May;19(3) :341-4．
18 罗宇 井晓蓉等．椎基底动脉供血不足性眩晕四种检查比较．临床脑电 学；1999；8：3． 154-156
19 Linthicum FH, Waldorf R, Luxford WM, Caltogirone S .Infrared/video ENG recording of eye movements to evaluate the inferior. Otolaryngol Head Neck Surg ,1988 Mar;98(3) :207-10
20 石明等．眼震电图对眩晕的鉴别诊断价值探讨．湖南医科大学学报，1997，22(2) ： 156-158．
21 Baloh RW, Honrubia V.Clinical neurophysiology of the vestibular system.Contemp Neurol Ser. 1979; 18:1-21．
22 Wilson VJ, Peterson BW, Fukushima K, Hirai N, Uchino Y.Analysis of vestibulocollic reflexes by sinusoidal polarization of vestibular afferent fibers.J Neurophysiol. 1979 Mar;42(2) :331-46．
23 Stroud MH, Newman NM, Keltner JL, Gay AJ.Abducting nystagmus in the medial longitudinal fasciculus (MLF) syndrome-internuclear ophthalmoplegia (INO).Arch Ophthalmol. 1974 Jul;92(1) :2-5．
24 Buizza A, Schmid R.Visual-vestibular interaction in the control of eye movement: mathematical modelling and computer simulation.Biol Cybern. 1982;43(3) :209-23．
25 Baloh RW, Yee RD, Honrubia V. Optokinetic asymmetry in patients with
maldeveloped foveas. Brain Res. 1980 Mar 17; 186( 1 ):211-6．
26 Ito M.Cerebellar control of the vestibulo-ocular reflex around the flocculus hypothesis.Annu Rev Neurosci. 1982;5:275-96．
27 Baloh RW, Yee RD, Kimm J, Honrubia V.Vestibular-ocular reflex patients with lesions involving the vestibulocerebellum.Exp Neurol. 1981 Apr;72(l):141-52．
28 Ito M, Shiida T, Yagi N, Yamamoto M.Visual influence on rabbit horizontal vestibulo-ocular reflex presumably effected via the cerebellar flocculus.Brain Res. 1974 Jan 4;65(1) : 170-4．
29 Kato I, Nakamura T, Kimura Y, Koike Y, Mizukoshi K.Visual-vestibular interaction in central nervous system disorders.Ann N Y Acad Sci. 1981 ;374:764-73．
30 Godaux E, Gobert C, Halleux J.Vestibuloocular reflex, optokinetic response, and their interactions in the alert cai.Exp Neurol. 1983 Apr;80(1) :42-54．
31 Godaux E, Vanderkelen B.Vestibulo-ocular reflex, optokinetic response and their interactions in the cerebellectomized cat.J Physiol. 1984 Jan;346:155-70．
32 Iwauga K, Morik. A case of HTLV-I associated myelopathy with flutter-like osillation. Rinsho, shinkeigaka 1993 Jan;37(1) :83-85, Japanese.
33 赵沛英等．视抑制试验的临床应用研究．中华耳鼻咽喉科杂志．1994：29． 6：359-361
34 Benitez JT.Eye-tracking and optokinetic tests: diagnostic significance in peripheral and central vestibular disorders. Laryngoscope. 1970 Jun;80(6) :834-48．
35 Kveton JF, Limb CJ, Bell MD.Comparison of optokinetic nystagmus elicited by full versus partial visual field stimulation: diagnostic implications. Otolaryngol Head Neck Surg. 1999 Jul;121(l):52-6． .
36 张素珍 姜泗长等。1000例眼震电图分析。中华耳鼻咽喉科杂志，1989； 24(6) ：355-358
37 单希征等．丛棘波在眼震电图中的意义．中华耳鼻咽喉科杂志，1992：27． 4：214-215
38 林尚泽 位置性眼震的临床意义。国外医学耳鼻咽喉科学分册，1998：22 (4) ： 227-228
39 Cawthome T．Examination of the vestibular system．Ann Otol Rhinol Laryngol．1968 Aug；77(4) ：727-32
40 王博惕 王丽雯．耳神经学．人民军医出版社，1987．